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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Tennessee rates for HCPCS L3675

Shoulder orthosis (SO), vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf

Rates data updated July 2026.

Facilitymedian $151 · 10th–90th $85$9120%20%10th90th$151Professionalmedian $91 · 10th–90th $78$1700%50%10th90th$91$0.2$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$95.50
Typical High
$151.36
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$91.20
Typical High
$169.82
BCBS
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$158.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$128.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$107.15
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$912.01
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,412.54
Typical High
$1,412.54
United
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$100.00
Typical High
$199.53
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$91.20
Typical High
$128.82